Cosmetic Lower Eyelid Surgery: Time to Pack Those Bags!

Bill Clinton.  If only I could get hold of his lower eyelids!  He’s a person who could really benefit from cosmetic lower eyelid surgery.  It’s pretty easy surgery to undergo, and I find myself wondering why he’s never done it.  I thought I’d spend a few minutes talking about how I do blepharoplasty surgery here in Fort Worth.

Anatomy of the lower eyelid

The eye is kind of like an ice cream cone.  The eyeball (the ice cream) is almost completely surrounded by bone (the cone).  The eye doesn’t rub on the bone, though.  The eyeball is separated from the bone by muscle and fat.  The muscles move the eye in its various directions.  Fat adds protection.  Over time, gravity pulls the fat down and it starts to bulge below the eyeball.  The eye has a little membrane called the orbital septum.  The septum acts as a sort of dam, holding the fat back in around the eye.  As we age the septum stretches.  This results in fatty bulges that are visible in the lower eyelids.

Dr. Kunkel doing blepharoplasty surgery
(This is me doing blepharoplasty surgery in a surgery center in Fort Worth)

Lower eyelid blepharoplasty technique

I like to try to blend the lower eyelid and cheek together.  There are a few ways to do this.  I make an incision inside the lower eyelid to manage the fatty fullness.  Through this inner incision I remove some of the bulging fat.  The septum (the ‘dam’) is released from its attachment to the rim of bone just beneath the eye.  A small amount of fat is then draped over that rim and sutured into the cheek tissues.  This blends the lower eyelid fat and the cheek fat, minimizing the indentation that used to separate the lower eyelid from the cheek.  An alternative to draping the fat over the bone is to inject some fat into that area.   A small amount of fat can be taken from the inner thigh and used in this way.

Once the fat has been manipulated, it’s time to address some of the loose skin.  I make an incision immediately below the eyelashes and remove a small amount of skin.  This results in a nearly imperceptible scar directly beneath the eyelashes.  When people come to my office to learn about lower eyelid surgery, we show them ‘before’ and ‘after’ photographs of some of my patients.  The images are magnified, and it’s almost impossible to see the scars.

In many cases I also perform a canthopexy toward the side of the eye.  One of the risks of lower eyelid surgery is that the lower eyelid can pull down after surgery.  Next time you’re at a fundraising event or major social function, look at the eyes of the people you talk to.  One of the ‘telltale’ signs of having undergone lower eyelid surgery is that you can see a strip of white between the lower eyelashes and the iris (the blue or brown or green colored area of the eye).  In a normal eye, you don’t see any white between the eyelashes and the iris.  If someone has had lower eyelid surgery and the lower eyelid pulls down a bit, you’ll see the strip of white.  I do a canthopexy to slightly tighten and support the lower eyelid to help prevent it from pulling down.  It’s a pretty simple part of the procedure that just takes a few minutes to perform but can help add a lifetime of benefit.

Recovery after cosmetic lower eyelid blepharoplasty

Of all the facial surgery I do, recovery from eyelid surgery is probably the easiest. Typically there’s very little pain involved. Some swelling and bruising take place. Most people are ready to be back in front of peers in a week or so, and the more adventurous can return to work within just a few days.  Some bruising and swelling will be noticeable to other people for about 3 or 4 weeks.  Once the bruising is gone, it’s usually pretty hard for other people to tell that you’ve had surgery.  It probably registers to them that something about you looks better but they can’t usually pinpoint exactly what.  Maybe you’ve been getting more rest?  Maybe you don’t have allergies?  Just can’t put a finger on what’s different.  I don’t want people to wear makeup for about 10 days or do strenuous exercising for about 4 weeks or so.  It’s not generally a difficult recovery.  It can be a little socially awkward for a couple of weeks.


Lower eyelid blepharoplasty surgery.  It’s a great procedure that can lead to wonderful results.  Give us a call to learn more!

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